Megaprosthesis in large bone defects: Opportunity or chimaera?

Calori, G.M.; Colombo, M.; Ripamonti, C.; Malagoli, E.; Mazza, Emílio; Fadigati, P.; Bucci, M.

doi:10.1016/j.injury.2013.09.015

Cited by 31 publications

(18 citation statements)

References 30 publications

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“…2 Structural allografts have a complication rate of 23-55% [18][19][20] and include allograft resorption, non-union, spontaneous fracture and infection. 21,22 In addition to the 2 0 1 6 ) 4 6 7 -4 7 1 complications reported with the use of allografts, one major disadvantage is that immediate full weight bearing is usually not possible, as the bone requires a period of time to consolidate.…”

Section: Discussionmentioning

confidence: 99%

“…However, in these complex cases, revision surgery using a megaprosthesis is the only option for preserving the extremity whilst allowing mobilisation and full weight-bearing as early as possible. 2 The study has several limitations. Due to the highly specialised and rare indications, the number of patients is small.…”

Section: 29mentioning

confidence: 98%

“…1 As such, tumour units have been able to combine the advances in metallurgical techniques with the need to replace large bone segments after resection for oncological indications. 2 Modular megaprosthesis are defined as special bone and joint prostheses, which can bridge and compensate for large bone defects caused by loss of bone stock. 3 An accurate incidence of peri-articular fractures of the knee is difficult to obtain as it varies with both geographic and population demographics.…”

Section: Introductionmentioning

confidence: 99%

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Megaprostheses in the management of trauma of the knee

Evans

Laugharne

Kotecha

et al. 2016

Journal of Orthopaedics

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Section: Discussionmentioning

confidence: 99%

Section: 29mentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

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Megaprostheses in the management of trauma of the knee

Evans

Laugharne

Kotecha

et al. 2016

Journal of Orthopaedics

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“…Traditional treatments may be used, such as bone transport with external fixator, autologous iliac crest grafts, microvascular fibula grafts, RIA system (Reamer / Irrigator / Aspirator); however, also indicated are biotechnological products, including cells, scaffold and growth factors, according to the principles of the ''biological chamber'' and "polytherapy" (8)(9)(10)(11)(12)(13)(14)(15)(16). Score from 76 to 100 may indicate the need for primary amputation, arthrodesis, prosthesis or mega-prosthesis implantation depending on the patient's condition, the severity of the bone loss and the anatomical localisation (17,18).…”

Section: From the Classification To The Development Of A Ladder Strategymentioning

confidence: 99%

Non-unions

Calori¹

2017

ccmbm

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SummaryNon-union of long bones is a significant consequence of fracture treatment. Bone regeneration is a complex physiological process of bone formation which can be seen during normal fracture healing. An improved understanding of the molecular and cellular events that occur during bone repair and remodelling has led to the development of biologic agents that can augment the biological microenvironment and enhance bone repair. Currently, there are different strategies to augment the impaired or "insufficient" bone-regeneration process, including the "gold standard" autologous bone graft, free fibula vascularised graft, allograft implantation, and use of growth factors, osteoconductive scaffolds, osteoprogenitor cells and distraction osteogenesis. A lack of standardized outcome measures for comparison of biologic agents in clinical fracture repair trials, frequent offlabel use and a limited understanding of the biological activity of these agents at the bone repair site have limited their efficacy in clinical applications.

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“…In patients who do not wish to consider primary amputation as a solution of their problem, our approach to provide a reasonable functional solution has been the replacement of all or part of the affected extremity with megaprosthesis. Our philosophy of substitution treatment can quickly restore function rather than chasing again unsuccessful attempts to reconstruction [6,7].…”

Section: Introductionmentioning

confidence: 99%

Reconstruction of patellar tendon following implantation of proximal tibia megaprosthesis for the treatment of post-traumatic septic bone defects

Mazza

Vaienti

Mazzola

et al. 2016

Injury

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Introduction: Latest advances made in joint replacement implants allows reconstruction of entire limbs. These special prostheses or megaprostheses were originally designed for the treatment of severe oncological bone loss. Nowadays, however, the indications and applications of these devices are expanding to other orthopaedic and trauma clinical conditions. Since 2008 we have implanted 152 megaprostheses in non-oncological conditions: 87 were implanted for post-traumatic failures aseptic/septic (represented by complex non-unions and critical size bone defects); 26 total femur, 52 distal femur and 9 proximal tibia. In this group of patients bone and soft tissues conditions are completely different compared to patients with oncological back ground. The presence of infection and previous surgeries can lead to adhesion, scar interference, muscular and tendon impairment and skin problems that lead to reduced function and severe joint stiffness. The purpose of this study is to evaluate the results of treatment of reconstruction of patellar tendon during implantation of proximal tibia megaprosthesis for the treatment of septic post traumatic critical bone defects. Patients and methods: In this retrospective study, we evaluated 9 patients treated with proximal tibia megaprosthesis who underwent patellar tendon reconstruction. All patients presented a complete patellar tendon disruption at the time of prosthesis implantation. Procedures of reconstruction included a tendon-plasty of quadriceps and/or patellar tendons, a pie crusting of quadriceps fascia, a reinforcement of the apparatus with synthetic tendon graft substitutes (LARS) and a medial gastrocnemius muscular flap to reconstruct the extensor mechanism and obtain skin coverage when needed. The average follow up was 18 months (9-36). For each of the cases, we analysed the complications occurred regarding septic recurrence, patellar fracture, quadriceps and patellar tendon rupture and number of reinterventions. The clinical outcome was assessed by the WOMAC Score. Results: In all cases there was no infection recurrence or skin related problems. None of the patients require prosthesis revision due to loosening or device failure. No patellar fracture or quadriceps tendon failure was recorded. One patient presented a rupture of the reconstructed patellar tendon due to a trauma incident 18 months after the implantation and he required revision surgery. From a clinical point of view the average WOMAC score was 62.4 at 1 month rising to 72.6 at 3 months, 78.2 at 6 months, 76.4 at 1 year and 74.8 at 18 months. Conclusion: When proximal tibia megaprosthesis is implanted and there are soft tissue and patellar tendon deficiency, soft tissue reconstruction can be achieved by appropriate lengthening of the tendon and a gastrocnemius flap reinforced by LARS. Such an approach allows restoration of the extensor mechanism and coverage of the prosthesis in an area where skin problems are frequently very common.

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Megaprosthesis in large bone defects: Opportunity or chimaera?

Cited by 31 publications

References 30 publications

Megaprostheses in the management of trauma of the knee

Megaprostheses in the management of trauma of the knee

Non-unions

Reconstruction of patellar tendon following implantation of proximal tibia megaprosthesis for the treatment of post-traumatic septic bone defects

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